Issue link: https://www.massageandbodyworkdigital.com/i/70065
TEXTING THUMB Since texting thumb, more commonly known as Blackberry thumb, has little research surrounding it, there are no standard treatment protocols at this time. Our training as massage therapists, however, has given us sufficient knowledge to analyze the anatomy and physiology involved in this technology-derived injury, and provide relief for our clients who may suffer from it. A TCM PERSPECTIVE The muscles of the thumb involved in thenar tendinitis are the opponens pollicus, pollicus brevis, adductor pollicus, flexor pollicus brevis, and abductor pollicus brevis. The innervation of these muscles is through the recurrent median nerve. Another group of muscles, namely the abductor pollicus longus and the extensor pollicus longus and brevis, are innervated by the posterior interosseous and radial nerves. From a TCM perspective, the primary meridians involved in thenar tendinitis are the lung and large intestine. The lung meridian runs ventrally, or medially, along the radial part of the arm and hand, crossing the thenar eminence and ending on the thumb. The large intestine meridian runs dorsally from the radial side of the index finger, over the cleft between thumb and index finger, and then up across the lateral and posterior part of the forearm. In TCM, pain from repetitive strain is due to qi (vital energy) and blood stagnation. The key concept here is that any stagnation of qi results in imbalance or disease. Massage therapists trained in Western anatomy and physiology will look for entrapments and impingements of nerves and blood vessels, because Western medical philosophy would say that muscles are contracted due to overuse flexion and adduction movements of mainly the pollicus muscles. An integrated Western approach that includes the disciplines of physical therapy, occupational therapy, and massage therapy would include: manual therapy like stretching (extending and abducting), ultrasound, microcurrent, galvanic electronic muscle stimulator (EMS) treatment, neuromuscular therapy, myofascial release, or painkillers (opiates). When the pain has substantially subsided, a strengthening program is introduced. In a TCM approach, acupressure and tui na (a Chinese hands-on therapy) are integrated to address local and distal points. Since tui na is comprehensive in scope, any underlying conditions that predisposed the client to this condition are also addressed. A typical cause of repetitive strain in TCM is the emotional driving force behind the actions and lifestyle of the individual. Some individuals are so highly driven that they become workaholics. Their mental attitude will cause an imbalance in their emotional state because while their egotistical side takes over (yang), their nurturing or caring side (yin) will be deficient. This causes a yin–yang imbalance. Being in the yang mode all the time also depletes viscera and tissues because there is insufficient rest for the tissues to regenerate. In TCM, the client's emotional well-being is the first concern of the therapist, because most issues with the body and viscera arise from an emotional imbalance. A QI PROBLEM Using tui na to address musculoskeletal pain, blood and qi are moved throughout the body. The process is called "dredging the meridians," and in the case of thenar tendinitis, it is done through the meridians of the lung and large intestine. In addition to carrying qi, every meridian also has musculoskeletal branches that feed qi and blood to the muscles and skin of an area. These branches concentrate on the surface of the body under the skin and in the fascia. 76 massage & bodywork november/december 2010 Hegu (LI 4) The LI 4 point on the large intestine meridian. If a musculoskeletal injury is left unattended, the stagnant qi will spread back from the surface to the organ itself. Generally, it is through the anatomical and physiological connection of meridians and their branches that various tissues and organs comprise an integrated whole. But that also means that existing conditions in the viscera, like the lung and large intestine, can predispose distal tissues to injury. On the basis of an organ's function in TCM, we can already determine the location and nature of a pathology or disease. For example, the spleen is, among other things, responsible for the nourishment of muscles. It converts food and drink to qi and transports this energy. When the spleen is healthy, the muscles are well-defined, strong, and flexible. When the spleen is diseased, muscular atrophy occurs, making the whole thenar eminence vulnerable to injury. The emotional state of the individual is also important when addressing this injury with TCM. In TCM, each organ has an emotional domain. Individuals who are frustrated, angry, and resentful, show an imbalance of the liver and can be predisposed easily to musculotendinous injury. The thenar eminence, for example, would become excessively vulnerable to